THE ROLE OF PHYSICAL ACTIVITY IN SLOWING PROGRESSION OF CHRONIC KIDNEY DISEASE - A NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6142Keywords:
Physical Activity, Chronic Kidney Disease (CKD), Exercise Training, GFR, MortalityAbstract
Chronic kidney disease (CKD) represents a substantial and growing global health dysfunction. The rising occurrence driven by aging populations and increasing rates of metabolic disorders. This disease causes kidney function to slowly get worse. In the early stages, there are often no symptoms, so it is usually diagnosed only after significant kidney damage has already happened. Current clinical and public health strategies prioritize early identification and risk reduction. Modifiable lifestyle factors - such as regular physical activity and effective weight management - play an important role in slowing disease progression and reducing the risk of end-stage renal disease requiring dialysis or kidney transplantation. This narrative review aims to investigate the relationship between physical activity and the slowing of chronic kidney disease progression in patients. This narrative review evaluates scientific literature published over the past 25 years. Relevant data were obtained from studies indexed in the PubMed and Scopus databases. Cohort studies, systematic reviews, and meta-analyses published in English were included. Across the analyzed studies, greater engagement in physical activity was consistently linked to lower all-cause mortality in patients with chronic kidney disease. Active individuals tended to report better quality of life and exhibited a more gradual reduction in kidney function compared to those with lower activity levels, which indicates that regular physical activity is associated with improved patient prognosis. Physical activity has been consistently connected to lower death rates in people with chronic kidney disease. In addition, higher levels of physical activity relate to better quality of life and a slower rate of disease progression when compared to inactive patients.
References
Stevens, P. E., Ahmed, S. B., Carrero, J. J., Foster, B., Francis, A., Hall, R. K., Herrington, W. G., Hill, G., Inker, L. A., Kazancıoğlu, R., Lamb, E. J., Lin, P., Madero, M., McIntyre, N. J., Morrow, K., Roberts, G., Sabanayagam, D., Schaeffner, E., Shlipak, M., & Onu, U. (2024). KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International, 105, S117–S314. https://doi.org/10.1016/j.kint.2023.10.018
Centers for Disease Control and Prevention. (2026). Chronic kidney disease in the United States. U.S. Department of Health and Human Services. https://www.cdc.gov/kidney-disease/media/pdfs/CKD-Factsheet-H.pdf
Hill, N. R., Fatoba, S. T., Oke, J. L., Hirst, J. A., O’Callaghan, C. A., Lasserson, D. S., & Hobbs, F. D. R. (2016). Global prevalence of chronic kidney disease: A systematic review and meta-analysis. PLoS ONE, 11, e0158765. https://doi.org/10.1371/journal.pone.0158765
Wilson, S., Mone, P., Jankauskas, S. S., Gambardella, J., & Santulli, G. (2021). Chronic kidney disease: Definition, updated epidemiology, staging, and mechanisms of increased cardiovascular risk. Journal of Clinical Hypertension, 23(4), 831–834. https://doi.org/10.1111/jch.14186
Drüeke, T. B., & Floege, J. (2020). Cardiovascular complications of chronic kidney disease: Pioneering studies. Kidney International, 98(3), 522–526. https://doi.org/10.1016/j.kint.2020.07.001
Amoah, W. W., Ihudiebube-Splendor, C., & Dzramado, V. L. (2025). Impact of chronic kidney disease on health-related quality of life in adults: A systematic review and meta-analysis protocol. Frontiers in Nephrology, 5, 1630718. https://doi.org/10.3389/fneph.2025.1630718
Theodorakopoulou, M., Iatridi, F., Giannopoulou, I., Karkamani, E., Karagiannidis, A. G., Sampani, E., Dipla, K., Sarafidis, P., & Boutou, A. (2024). Physical activity in patients with chronic kidney disease: The effects of caregivers and residential factors. Cureus, 16(11), e74525. https://doi.org/10.7759/cureus.74525
Wilkinson, T. J., Clarke, A. L., Nixon, D. G. D., Hull, K. L., Song, Y., Burton, J. O., Yates, T., & Smith, A. C. (2021). Prevalence and correlates of physical activity across kidney disease stages: An observational multicentre study. Nephrology Dialysis Transplantation, 36(4), 641–649. https://doi.org/10.1093/ndt/gfz235
Hirai, K., Ookawara, S., & Morishita, Y. (2016). Sarcopenia and physical inactivity in patients with chronic kidney disease. Nephro-Urology Monthly, 8(3), e37443. https://doi.org/10.5812/numonthly.37443
MacKinnon, H. J., Wilkinson, T. J., Clarke, A. L., Gould, D. W., O’Sullivan, T. F., Xenophontos, S., Watson, E. L., Singh, S. J., & Smith, A. C. (2018). The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in nondialysis chronic kidney disease: A systematic review. Therapeutic Advances in Chronic Disease, 9(11), 209–226. https://doi.org/10.1177/2040622318785575
Martins, P., Marques, E. A., Leal, D. V., Ferreira, A., Wilund, K. R., & Viana, J. L. (2021). Association between physical activity and mortality in end-stage kidney disease: A systematic review of observational studies. BMC Nephrology, 22(1), 227. https://doi.org/10.1186/s12882-021-02407-w
Vanden Wyngaert, K., Van Craenenbroeck, A. H., Van Biesen, W., Dhondt, A., Tanghe, A., Van Ginckel, A., Celie, B., & Calders, P. (2018). The effects of aerobic exercise on eGFR, blood pressure and VO2 peak in patients with chronic kidney disease stages 3–4: A systematic review and meta-analysis. PLoS ONE, 13(9), e0203662. https://doi.org/10.1371/journal.pone.0203662
Robinson-Cohen, C., Littman, A. J., Duncan, G. E., Weiss, N. S., Sachs, M. C., Ruzinski, J., Kundzins, J., Rock, D., de Boer, I. H., Ikizler, T. A., Himmelfarb, J., & Kestenbaum, B. R. (2014). Physical activity and change in estimated GFR among persons with CKD. Journal of the American Society of Nephrology, 25(2), 399–406. https://doi.org/10.1681/ASN.2013040392
Zhang, L., Wang, Y., Xiong, L., Luo, Y., Huang, Z., & Yi, B. (2019). Exercise therapy improves eGFR, and reduces blood pressure and BMI in non-dialysis CKD patients: Evidence from a meta-analysis. BMC Nephrology, 20(1), 398. https://doi.org/10.1186/s12882-019-1586-5
Clyne, N., & Anding-Rost, K. (2021). Exercise training in chronic kidney disease—Effects, expectations and adherence. Clinical Kidney Journal, 14(Suppl. 2), ii3–ii14. https://doi.org/10.1093/ckj/sfab012
Pei, G., Tang, Y., Tan, L., Tan, J., Ge, L., & Qin, W. (2019). Aerobic exercise in adults with chronic kidney disease (CKD): A meta-analysis. International Urology and Nephrology, 51(10), 1787–1795. https://doi.org/10.1007/s11255-019-02234-x
Chen, C. C., Huang, Y. Y., Zhang, H., Liu, X., Li, X. Q., Long, Y. Q., Chen, Z. W., & Jin, T. (2024). Impact of resistance exercise on patients with chronic kidney disease. BMC Nephrology, 25(1), 115. https://doi.org/10.1186/s12882-024-03547-5
Cheema, B. S., Chan, D., Fahey, P., & Atlantis, E. (2014). Effect of progressive resistance training on measures of skeletal muscle hypertrophy, muscular strength and health-related quality of life in patients with chronic kidney disease: A systematic review and meta-analysis. Sports Medicine, 44, 1125–1138. https://doi.org/10.1007/s40279-014-0176-8
Marinho, S. M. S. D. A., Mafra, D., Pelletier, S., Hage, V., Teuma, C., Laville, M., Eduardo, J. C. C., & Fouque, D. (2016). In hemodialysis patients, intradialytic resistance exercise improves osteoblast function: A pilot study. Journal of Renal Nutrition, 26, 341–345. https://doi.org/10.1053/j.jrn.2016.03.002
Tsai, Y. C., Chen, H. M., Hsiao, S. M., Chen, C. S., Lin, M. Y., Chiu, Y. W., Hwang, S. J., & Kuo, M. C. (2017). Association of physical activity with cardiovascular and renal outcomes and quality of life in chronic kidney disease. PLoS ONE, 12(8), e0183642. https://doi.org/10.1371/journal.pone.0183642
Sprick, J. D., Mammino, K., Jeong, J., DaCosta, D. R., Hu, Y., Morison, D. G., Nocera, J. R., & Park, J. (2022). Aerobic exercise training improves endothelial function and attenuates blood pressure reactivity during maximal exercise in chronic kidney disease. Journal of Applied Physiology, 132(3), 785–793. https://doi.org/10.1152/japplphysiol.00808.2021
Yamamoto, S., Matsuzawa, R., Hoshi, K., Harada, M., Watanabe, T., Suzuki, Y., Isobe, Y., Imamura, K., Osada, S., Yoshida, A., Kamiya, K., & Matsunaga, A. (2021). Impact of physical activity on dialysis and nondialysis days and clinical outcomes among patients on hemodialysis. Journal of Renal Nutrition, 31(4), 380–388. https://doi.org/10.1053/j.jrn.2020.07.007
Scapini, K. B., Bohlke, M., Moraes, O. A., Rodrigues, C. G., Inácio, J. F., Sbruzzi, G., Leguisamo, C. P., Sanches, I. C., Tourinho Filho, H., & Irigoyen, M. C. (2019). Combined training is the most effective training modality to improve aerobic capacity and blood pressure control in people requiring haemodialysis for end-stage renal disease: Systematic review and network meta-analysis. Journal of Physiotherapy, 65(1), 4–15. https://doi.org/10.1016/j.jphys.2018.11.008
Beddhu, S., Baird, B. C., Zitterkoph, J., Neilson, J., & Greene, T. (2009). Physical activity and mortality in chronic kidney disease (NHANES III). Clinical Journal of the American Society of Nephrology, 4(12), 1901–1906. https://doi.org/10.2215/CJN.01970309
Hayden, C. M. T., Begue, G., Gamboa, J. L., Baar, K., & Roshanravan, B. (2024). Review of exercise interventions to improve clinical outcomes in nondialysis CKD. Kidney International Reports, 9(11), 3097–3115. https://doi.org/10.1016/j.ekir.2024.07.032
Chang, Y.-T., Wu, H.-L., Guo, H.-R., Cheng, Y.-Y., Tseng, C.-C., Wang, M.-C., Lin, C.-Y., & Sung, J.-M. (2011). Handgrip strength is an independent predictor of renal outcomes in patients with chronic kidney diseases. Nephrology Dialysis Transplantation, 26(11), 3588–3595. https://doi.org/10.1093/ndt/gfr013
Jones, C. J., Rikli, R. E., & Beam, W. C. (1999). A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Research Quarterly for Exercise and Sport, 70(2), 113–119. https://doi.org/10.1080/02701367.1999.10608028
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Copyright (c) 2026 Iia Zhaharina, Yaryna Manila, Yuliia Dubova, Aleksandra Kłuś, Aneta Kasperska, Łukasz Kobiałkowski, Hanna Markowska, Martyna Sienicka, Alina Biletska, Valery Doroshkov
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